Inhaled Treatment for Bronchopulmonary Dysplasia

Inclusion Criteria: 1. Inborn or outborn infants of either sex or any race or ethnicity 2. \<32 weeks gestation at birth (best obstetrical dating) 3. Aged 29 to 365 days 4. Refractory hypoxic respiratory failure (average daily FiO2 \>35% for 5 days) 5. Requires mechanical ventilation via endotracheal airway Exclusion Criteria: 1. Life-threatening congenital or acquired anomalies (lethal chromosomal, thoracic/cardiac, brain) 2. Unstable condition defined as severe hypoxemia (FiO2 \>85% for \>24hrs), sepsis, or hypotension 3. Baseline methemoglobin \> 3%, congenital methemoglobinemia, or a familial hemoglobinopathy 4. On steroid to facilitate endotracheal extubation 5. Individuals on inhaled nitric oxide, a phosphodiesterase 5 (PDE-5) inhibitor, taking allopurinol, β-adrenergic blockers, tricyclic antidepressants, meperidine (or related CNS agents), or nitrates 6. Thrombocytopenia defined as \<50,000 platelets/µL on weekly NICU labs, clinical evidence of bleeding, on an anti-coagulant, or individuals with an inherited or acquired coagulation disorder 7. Anemia defined as a hemoglobin of \< 9 mg/dL on weekly NICU labs 8. Concerns for pre-existing liver damage defined as an AST/ALT \> 50 IU/L or direct bilirubin \>1 mg/dL on weekly NICU labs 9. Concerns for acute kidney injury defined as a serum creatinine \> 0.7 mg/dL on weekly NICU labs or 24-hr urine output \<1.0 ml/kg/hr during preceding 4 days 10. Patients that are ventilated with a device not certified for blending of aerosolized solutions into the ventilator circuit 11. Physician of record opposed to enrolling the patient due to perceived safety concerns; or any condition that does not allow the protocol to be followed safely 12. Subjects that have experienced cardiac arrest with CPR for longer than 30 minutes